Abstract Body (Do not enter title and authors here): Introduction: Tricuspid Regurgitation (TR) is a valvular disorder associated with significant morbidity and mortality, with current therapeutic options centered on symptom control or surgical alternatives. Sodium-glucose cotransporter-2 inhibitors (SGLT2i), initially developed for diabetes have demonstrated cardiovascular benefits in heart failure patients though the effect on valvular diseases, in particular, tricuspid regurgitation remains unexplored.

Research Question: Whether sodium-glucose cotransporter-2 inhibitors reduce adverse clinical outcomes in patients with tricuspid regurgitation vs those not on the medication.

Goals: Investigate the association between sodium-glucose cotransporter-2 inhibitor use and clinical outcomes including mortality, cardiogenic shock, and hospitalizations for patients with tricuspid regurgitation without heart failure with reduced ejection fraction or prior triscupid valve interventions.

Methods: A retrospective cohort study was conducted by querying the TriNetX database. Patients with tricuspid regurgitation were indentified via ICD codes, excluding those with heart failure with reduced ejection fraction or prior tricuspid valve surgery. Propensity score matching was performed for demographics, comorbidities, and medications. Primary outcomes include all-cause mortality, cardiogenic shock, and need for cardiac procedures. Secondary outcomes include acute kidney injury, heart failure with reduced ejection fraction, hospitalizations, and pulmonary hypertension. Cox proportional hazards models and Kaplan-Meier survival analyses were used with a signifiance threshold of P<0.05.

Results: After propensity score matching, 50,514 patients were included in each group. Sodium-glucose cotransporter-2 inhibitor use was associated with a 49.9% reduction in all cause mortality (Hazard ratio: 0.501, 0.483-0.519), 20% lower risk of cardiogenic shock, and 17.7% fewer hospitalizations. Secondary outcomes showed decreased risks of acute kidney injury, recurrent urinary tract infections and pulmonary hypertension. No difference was observed in the need for cardiac procedures or incidence of heart failure with reduced ejection fraction.

Conclusion: Sodium-Glucose cotransporter-2 inhibitor use is associated with significantly improved survival and reduced adverse cardiovascular events. These findings suggest a potential therapeutic role for these agents and warrant prospective investigation.